Researchers identified three factors that may increase a child's risk of having intractable epilepsy -- a form of the disease that does not respond to commonly used drugs.
The findings may spare both patients and families the devastating medical, social and economic consequences of searching for appropriate treatments, the researchers say.
"If an adult experiences something and that adult has developed normally, then that adult knows how to function in the world," says lead author Anne Berg, an associate professor in biological sciences at Northern Illinois University in DeKalb. "But if children get a disease at a critical time in their development, like children with intractable epilepsy experience, and they miss out on developmental milestones, than they can have a rougher time in life. So finding a good treatment for epilepsy right from the beginning is critical."
Starting in 1993, Berg and her colleagues began following 613 epileptic children from Connecticut to see whether they could pin down what factors might predict intractable epilepsy.
"We were trying to identify which child might present with the severer forms of epilepsy, so that physicians can determine quickly if that child is going to have trouble," Berg says. "And after 20 years of no new drugs, suddenly there are seven or eight new drugs as well as newer therapies or earlier interventions like surgery. This research will allow doctors to identify children that might need a different or more aggressive approach."
Epilepsy is characterized by unprovoked, recurrent seizures that affect a person's physical, mental or behavioral functions. An estimated 2.3 million Americans have the disorder, according to the Epilepsy Foundation. In the United States, there are approximately 125,000 new cases each year, 30 percent of them in people under the age of 18. The vast majority of new cases occur in children 2 and under.
Berg identified three factors that increase the risk of having intractable epilepsy.
Children who have their first epileptic seizure before their first birthday -- called cryptogenic/symptomatic generalized epilepsy -- are at greatest risk, Berg says. Her study shows that 35 percent of the children with this type of epilepsy will go on to develop the intractable form of the disease.
Those children whose seizures occur more than once a month when they first develop epilepsy are also at greater risk, Berg says. "Probably the most important finding to my mind was how fast the seizures come on initially and how frequent the child has the seizures," she explains. "We found evidence that the higher the frequency, the more the probability of intractability."
"We also found that children who had a particular abnormality on their electroencephalogram (EEG) tests, called focal slowing, were also at increased risk for intractable epilepsy," she says. Focal slowing is slower electrical activity in a particular area of the brain.
"These three factors do not mean that doctors need to do anything special right away," Berg says. "A lot of these children do well on currently available medications and treatment. But if doctors see these abnormalities, certain red flags should go off, and they might want to explore some of the newer treatments."
The research is significant and important, says Dr. Gregory Holmes, a professor of neurology at Harvard Medical School.
"What a lot of people do not realize is how devastating epilepsy can be, especially in children," says Holmes, who wrote the editorial accompanying Berg's article in the June 12, 2001, issue of Neurology.
"But for about 25 percent of children, it can be an absolutely devastating disorder," Holmes explains. "Poorly controlled and recurrent seizures can injure the brain, and take a toll on intelligence and even behavior. So the critical questions is: Can we identify those children who are likely to develop the medically resistant epilepsy and then develop treatment early?"
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